Healthcare Provider Details

I. General information

NPI: 1225403363
Provider Name (Legal Business Name): JENNIFER M WILSON AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S DOWNING ST
DENVER CO
80210-5817
US

IV. Provider business mailing address

1391 SPEER BLVD SUITE 600
DENVER CO
80204-2508
US

V. Phone/Fax

Practice location:
  • Phone: 303-778-1955
  • Fax:
Mailing address:
  • Phone: 303-561-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number0992096
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number0992096
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number0992096
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: